• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1634-1641
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• 2000

Objective : The cerebrospinal fluid(CSF) pulsates within the craniospinal axis in response to rhythmic cerebral blood volume variation during the cardiac cycle. The aim of this study is to characterize the normal and abnormal CSF flow and its waveforms in the cervical spinal subarachnoid space. Methods : The magnetic resonance(MR) images were obtained with 1.5 T(GE Signa, GE Medical Systems, Milwaukee, USA) unit using the 2 dimensional cine PC(phase contrast) sequence with cardiac gating and gradient recalled echo imaging. This pulse sequence yielded 16 quantitative flow-encoded images per cardiac cycle. Sagittal and axial images of the cervical spinal CSF space were obtained, and target sites were analyzed for characteristic CSF flow (TR=50ms, TE=12.5-15ms). The region of interest(ROI) was 1mm 3 in volume. Twenty six persons were included in this study : 10 healthy volunteers and 16 patients with cervical myelopathy. The post-operative cine MR study were also done in five patients. Results : The normal CSF pulsation dynamics in the cervical spine showed discrete systolic and diastolic components. The CSF flow revealed a sine wave pattern, in which the systolic phase was shorter than the diastolic phase(ratio=2 : 3). The patient group revealed decreased amplitudes of the CSF flow and irregularly distored flow waves. The systolic phase was elongated in the ROI above the stenotic level, whereas the diastolic phase was lengthened below the level. In the postoperative images, the abnormal pattern and amplitude were found to be corrected. Conclusion : From these results, the authors believe that the CSF flow study provides valuable informations regarding the extent of cervical stenosis and may be useful for the surgical planning and post-operative evaluation.

• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.189-197
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• 2021

Objective : This study aims to investigate the relationship between aneurysm wall enhancement and clinical rupture risks based on the magnetic resonance vessel wall imaging (MR-VWI) quantitative methods. Methods : One hundred and eight patients with 127 unruptured aneurysms were prospectively enrolled from Feburary 2016 to October 2017. Aneurysms were divided into high risk (≥10) and intermediate-low risk group (<10) according to the PHASES (Population, Hypertension, Age, Size of aneurysm, Earlier SAH history from another aneurysm, Site of aneurysm) scores. Clinical risk factors, aneurysm morphology, and wall enhancement index (WEI) calculated using 3D MR-VWI were analyzed and compared. Results : In comparison of high-risk and intermediated-low risk groups, univariate analysis showed that neck width (4.5±3.3 mm vs. 3.4±1.7 mm, p=0.002), the presence of wall enhancement (100.0% vs. 62.9%, p<0.001), and WEI (1.6±0.6 vs. 0.8±0.8, p<0.001) were significantly associated with high rupture risk. Multivariate regression analysis revealed that WEI was the most important factor in predicting high rupture risk (odds ratio, 2.6; 95% confidence interval, 1.4-4.9; p=0.002). The receiver operating characteristic (ROC) curve analysis can efficiently differentiate higher risk aneurysms (area under the curve, 0.780; p<0.001) which have a reliable WEI cutoff value (1.04; sensitivity, 0.833; specificity, 0.67) predictive of high rupture risk. Conclusion : Aneurysms with higher rupture risk based on PHASES score demonstrate increased neck width, wall enhancement, and the enhancement intensity. Higher WEI in unruptured aneurysms has a predictive value for increased rupture risk.

• Journal of the Korean Society of Radiology
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• v.83 no.3
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• pp.486-507
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• 2022

Cerebral small vessel disease (CSVD) includes vascular lesions detected on brain MRI, such as white matter hyperintensities, lacunar infarctions, microbleeds, or enlarged perivascular spaces. There is accumulating evidence that vascular changes may play an important role in development of Alzheimer's disease (AD), and CSVD lesions detected on brain MRI were reported to be associated with β-amyloid and tau proteins accumulation. As the vascular contribution has therapeutic potential, it is important to understand the association of CSVD with AD and AD biomarkers. This review begins with a brief introduction of AD and AD biomarkers, explains the association between AD and vascular changes, and then details the pathogenesis and MR imaging findings of CSVD. Afterwards, we discuss the association of CSVD with AD and AD biomarkers.

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.365-378
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• 2020

Purpose This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease. Materials and Methods One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis. Results PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0-F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis. Conclusion PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

• Investigative Magnetic Resonance Imaging
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• v.6 no.2
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• pp.120-128
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• 2002

Purpose : To demonstrate that the relaxographic method provides additional information such as the distribution of relaxation times and water content which are poentially applicable to clinical medicine. Materials and Methods : First, the computer simulation was performed with the generated relaxation data to verify the accuracy and reliabilility of the relaxographic method (CONTINI). Secondly, in or der to see how well the CONTIN quantifies and resolves the two different ${T_1}$ environments, we calculated the oil to water peak area ratios and identified peak positions of ${T_1}-distribution$ curve of the phantom solutions, which consist of four centrifugal tubes (10 ml) filled with the compounds of 0, 10, 20, 30% of corn oil and distilled water, using CONTIN. Finally, inversion recovery MR images for a volunteer are acquired for each TI ranged from 40 to 1160 msec with TR/TE=2200/20 msec. From the 3 different ROIs (GM, WM, CSF), CONTIN analysis was performed to obtain the ${T_1}$-distribution curves, which gave peak positions and peak area of each ROI location. Results : The simulation result shows that the errors of peak positions were less in the higher peak (centered ${T_1}=600$ msec) than in the lower peak (centered ${T_1}=150$ msec) for all SNR but the errors of peak areas were larger in the higher peak than in the lower peak. The CONTIN analysis of the measured relaxation data of phantoms revealed two peaks between 20 and 60 msec and between 500 and 700 msec. The analysis gives the peak area ratio as oil 10%: oil 20%: oil 30% = 1:1.3:1.9, which is different from the exact ratio, 1:2:3. For human brain, in ROI 3 (CSF), only one component of -distributions was observed whereas in ROI 1(GM) and in ROI 2 (WM) we observed two components of ${T_1}-distribution$. For the WM and CSF there was great agreement between the observed ${T_1}-relaxation$ times and the reported values. Conclusion : we demonstrated that the relaxographic method provided additional information such as the distribution of relaxation times and water content, which were not available in the routine relaxometry and ${T_1}/{T_2}$ mapping techniques. In addition, these additional information provided by relaxographic analysis may have clinical importance.

• Journal of the Korean Society of Radiology
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• v.83 no.5
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• pp.1071-1080
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• 2022

Purpose To compare the MR findings of septic and acute gouty arthritis of the knee joint. Materials and Methods This retrospective study included patients who underwent knee MRI for septic or gouty arthritis at our hospital between October 2012 and October 2018. The MR findings were analyzed for the presence of bone marrow edema, soft tissue edema, abscess, pattern of synovial thickening (frondlike, lamellated, diffuse linear), maximum thickness of the synovium, and joint effusion volume. The gouty (n = 5) and septic arthritis (n = 10) groups were compared using the Wilcoxon rank-sum test and Fisher's exact test. Results No statistically significant differences were observed for each item. One patient in the gouty arthritis group and seven in the septic arthritis group had bone marrow edema. Soft tissue abscess formation was only observed in the septic group. The incidence of each synovial thickening pattern was as follows: 100% (diffuse linear) in the gouty arthritis group and 20% (frondlike), 50% (lamellated), and 30% (diffuse linear) in the septic arthritis group. Conclusion Differentiation of gouty arthritis and septic arthritis based on imaging findings is difficult. However, lamellated synovial thickening patterns, bone marrow edema, and soft tissue abscess formation are more commonly observed in patients with septic arthritis than in those with gouty arthritis.

• Journal of the Institute of Electronics Engineers of Korea SP
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• v.39 no.5
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• pp.544-555
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• 2002

The aim of this study is to develop the $^1H$-MRS data postprocessing software for both single-voxel and multi-voxel technique, which plays and important role as a diagnostic tool in clinical field. This software is based on graphical user interface(GUI) under windows operating system of personal computer(PC). In case of single-voxel MRS, both of raw data in time-domain and spectrum data in frequency-domain are simultaneously displayed in a screen. Several functions such as DC correction, zero filling, line broadening, Lorentz-Gauss filtering and phase correction, etc. are included to increase the quality of spectrum data. In case of multi-voxel analysis, spectroscopic image reconstructed by 3-D FFT was displayed as a spectral grid and overlapped over previously obtained T1- or T2-weighted image for the spectra to be spatially registered with the image. The analysis of MRS peaks were performed by obtaining the ratio of peak area. In single-voxel method, statistically processed peak-area ratios of MRS data obtained from normal human brain are presented. Using multi-voxel method, MR spectroscopic image and metabolite image acquired from brain tumor are demonstrated.

• Investigative Magnetic Resonance Imaging
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• v.13 no.2
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• pp.161-170
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• 2009

Purpose : A parallel imaging method provides us to improve temporal resolution to obtain three-dimensional (3D) MR images. The objective of this study was to optimize three 3D MRI techniques by adjusting 2D SESNE factors of the parallel imaging method in phantom and human brain. Materials and Methods : With a 3 Tesla MRI system and an 8-channel phase-array sensitivity-encoding (SENSE) coil, three 3D MRI techniques of 3D T1-weighted imaging (3D T1WI), 3D T2-weighted imaging (3D T2WI) and 3D fluid attenuated inversion recovery (3D FLAIR) imaging were optimized with adjusting SESNE factors in a water phantom and three human brains. The 2D SENSE factor was applied on the phase-encoding and the slice-encoding directions. Signal-to-noise ratio(SNR), percent signal reduction rate(%R), and contrast-to-noise ratio(CNR) were calculated by using signal intensities obtained in specific regions-of-interest (ROI). Results : In the phantom study, SENSE factor = 3 was provided in 0.2% reduction of signals against without using SENSE with imaging within 5 minutes for 3D T1WI. SENSE factor = 2 was provided in 0.98% signal reduction against without using SENSE with imaging within 5 minutes for 3D T2WI. SENSE factor = 4 was provided in 0.2% signal reduction against without using SENSE with imaging around 6 minutes for 3D FLAIR. In the human brain study, SNR and CNR were higher with SENSE factors = 3 than 4 for all three imaging techniques. Conclusion : This study was performed to optimize 2D SENSE factors in the three 3D MRI techniques that can be scanned in clinical time limitations with minimizing SNR reductions. Without compromising SNR and CNR, the optimum 2D SENSE factors were 3 and 4, yielding the scan time of about 5 to 6 minutes. Further studies are necessary to optimize 3D MRI techniques in other areas in human body.

• Investigative Magnetic Resonance Imaging
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• v.3 no.2
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• pp.146-153
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• 1999

Purpose : To evaluate the proton MR spectroscopy (MRS) findings of early and late ischemic infarcts and to compare these MRS findings with clinical symptoms. Materials and Methods : We obtained MRs spectra of 28 consecutive patients with early ischemic infarct (15 me, 13 women) between 2-10 (mean 6.2) days after stroke onset. Follow-up MRS was carried out between 20-32 (mean 25) days in 12 patients. The MRs spectra were acquired at 1.5T MR unit using single voxel technique with PRESS sequence, TR of 2000ms, TE of 288 (144)ms, and voxel size of 2cm x 2cm x 2cm in the three areas; an infarct lesion, the brain parenchyma adjacent to the lesion, and contralateral normal brain parenchyma. The NAA/creatine, choline/creatine, and lactate/creatine ratios were calculated in each spectrum. The spectra of MRS were compared with clinical symptoms. Results : In early infarct, decreased NAA/creatine ratio (n=22) and increased lactate/creatine ratio (n=25) were found in the infarct lesion. Choline/creastine ratio was within normal range (n=25). On follow-up MRS in late stage, NAA/creatine ratio in the infarct lesion decreased further (n=5), did not change (n=6), or increased (n=1). Lactate/creatine ratio became less elevated (n=10), or did not changed (n=2). Choline/creatine ratio had a trend for increase. The decreased NAA/creatine and increased lactate/creatine ratios were correlated well with the severity of symptoms, respectively. Conclusion : Decreased NAA/creatine and increased lactate/creatine ratios were common MRS findings characteristic in early ischemic infarct and correlated well with clinical severity. On follow-up MRS in late stage, NAA/creatine ratio decreased further or did not change, and lactate/creatine ratio became less elevated.

• Korean Journal of Radiology
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• v.22 no.11
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• pp.1886-1893
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• 2021

Objective: To assess the feasibility of quantitatively assessing pancreatic steatosis using magnetic resonance imaging (MRI) and its correlation with obesity and metabolic risk factors in pediatric patients. Materials and Methods: Pediatric patients (≤ 18 years) who underwent liver fat quantification MRI between January 2016 and June 2019 were retrospectively included and divided into the obesity and control groups. Pancreatic proton density fat fraction (P-PDFF) was measured as the average value for three circular regions of interest (ROIs) drawn in the pancreatic head, body, and tail. Age, weight, laboratory results, and mean liver MRI values including liver PDFF (L-PDFF), stiffness on MR elastography, and T2^* values were assessed for their correlation with P-PDFF using linear regression analysis. The associations between P-PDFF and metabolic risk factors, including obesity, hypertension, diabetes mellitus (DM), and dyslipidemia, were assessed using logistic regression analysis. Results: A total of 172 patients (male:female = 125:47; mean ± standard deviation [SD], 13.2 ± 3.1 years) were included. The mean P-PDFF was significantly higher in the obesity group than in the control group (mean ± SD, 4.2 ± 2.5% vs. 3.4 ± 2.4%; p = 0.037). L-PDFF and liver stiffness values showed no significant correlation with P-PDFF (p = 0.235 and p = 0.567, respectively). P-PDFF was significantly associated with obesity (odds ratio 1.146, 95% confidence interval 1.006-1.307, p = 0.041), but there was no significant association with hypertension, DM, and dyslipidemia. Conclusion: MRI can be used to quantitatively measure pancreatic steatosis in children. P-PDFF is significantly associated with obesity in pediatric patients.